Global Insight

By Dr Stephanie Woo, O.D.

After the blood, sweat and tears that optometry school can create, we are all at the same point on that graduating day. Where will we go? What will we do? Where will we live? What will our life be like? It can be extremely exciting but also terrifying. There are many unknowns as a new doctor, and that can be a scary thing. Hopefully, some of these tips can better prepare you for what to expect in the real world! There are 10 things I wish I knew before graduating optometry school:

1. Patients lie…a lot! 

Patients will lie about things like sleeping in their contacts, replacing their contacts on a daily, bi-weekly, or monthly basis. I found it interesting when I would ask full-time contact lens wearers about their lens care habits and they would say they never slept in their lenses and always threw them away at the end of the month, however in their chart, they ordered their annual supply 15 months ago. Hmm, the math doesn’t add up? They also lie about taking their eye drops – this can make life extremely difficult because if the problem is not clearing up, and you are under the assumption that the patient is using their drops as prescribed, you may switch eye drops not knowing the real reason was because they weren’t using them in the first place!

2. Managing patients is easy, managing staff is the hard part. 

My dad actually told me this a long time ago (he is a medical doctor who owns his own practice). I, of course, never believed him because during school it took all of my effort just to get a view of the optic nerve, let alone figuring out what the diagnosis was with my patient! As I began seeing more patients and improving my clinical skills, it did become apparent more and more that seeing patients and managing their eye care was the easy part. Managing the staff schedules, vacation, drama within the office, new hires, etc definitely became the more difficult challenge to master.

3. Everything gets easier the more you practice. 

Trying to remove a gas permeable lens by using the patient’s lids and not using a plunger?! How on earth will I ever get this thing out?! I thought this during my contact lens clinic probably 100 times. I could never seem to get the eyelids in the perfect position to dislodge the lens, and I kept saying to myself, “Can’t I just use a plunger to get this thing off?!” You can’t expect to get better at something by not practising – the only way to improve is to practice, practice, practice! Now I can do it practically in my sleep.

4. The lady with the bag of glasses – you can’t help her. 

This is a patient who comes in with 15 pairs of glasses all from other eye doctors and no one can get her prescription right. In the early days, you might think ‘ok great I got this. I can help her.’ I was that way. Now I run for the hills anytime bag‐o‐glasses patient shows up. It is usually a psychological thing, not a glasses thing, unfortunately. Educating the patient that you might not be able to help them is a good approach.

5. You won’t need to do the 40 step eye exam on every patient. 

During school, it is very important to do every single test on every comprehensive exam so that you become proficient at each skill. However, when the real world hits, not every single comprehensive exam will need vergences or multiple amplitude tests or phoria testing. Some doctors prefer to do all of these tests on every patient, but the majority will limit their testing to the patient at hand and base it off the reason they are here (maybe we don’t need to do 20 minutes of phoria/vergence testing if they are here for a simple contact lens check). You will learn this as you see patients, and you’ll become more efficient with time.

6. Older generation optometrists are notorious for giving away services for low or no cost at times – Do not follow this mindset! 

Younger ODs value their time and service more, but this is an interesting time because patients may be used to getting services for low or no cost ie “my last eye doctor never charged me a contact lens evaluation fee.” Do not give in to these crazy demands. You went to school for years and dedicated time, money, and hard work into helping people see. You deserve to get paid for your time. I joined a practice where there were very low or no contact lens fees. Because I valued my time and expertise, I began charging patients the fair market value, and there was huge pushback for about 2 years. Now, the patients are well aware of all costs prior to their exam, but it took a while to break through that ceiling. If you find yourself in this situation, keep pushing. It is worth it and YOU are worth it!

7. Get good at billing and coding yesterday. 

Many ODs are paid on a production model, so it is super important that you are aware of what codes to use and when. During your rotations, ask a lot of questions to your mentor ODs and take good notes so that you can get a good grasp on billing and coding.

8. You could save a life! 

Being an eye doctor is very rewarding and there are many instances where optometrists have saved lives by detecting critical systemic issues such as hypertension, diabetes, high cholesterol, multiple sclerosis, stroke, etc. I recently had a patient who was having some blurry vision, and after running a battery of tests, she had a bilateral hemianopsia. I sent her to the ER and the doctor confirmed she was having a stroke! Amazing that just one small piece of information led us to the diagnosis.

9. Go with your gut. 

If something is not sitting right with you, take action. If the patient has 20/30 vision and they have a cataract, you could say their vision is decreased due to the cataract. However, if your gut just says something different, listen to it. If a patient has a headache and you don’t find anything with their eyes, but your gut says something else might be wrong, send them for an MRI or send them to their PCP. Usually, your gut is right; trust it.

10. You will be a true EXPERT in eye care. 

No, not like the expert carpet cleaner down the street who just opened up his business 1 day ago. I mean a REAL expert – they say it takes 10,000 hours to become an expert at something. After seeing patients for 10,000 hours (assuming you see patients 40 hours per week and about 50 weeks per year), you will become an expert in eye care in 5 years! And that’s not including all of the hours in optometry school you’ve spent dedicating all of your brainpower to the human eye! This is something to be incredibly proud of – optometrists are absolute experts not only with regards to the human eye, but the entire visual system and sometimes how it connects to the human body.

Thank you to Dr Stephanie Woo, O.D. for contributing to Global Insight.